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Journal of Research in Nursing logoLink to Journal of Research in Nursing
. 2019 Jun 8;24(3-4):250–262. doi: 10.1177/1744987118812537

Juggling to survive: Master of Science postgraduate nursing students’ experiences of studying far from home

Kathleen Markey 1,✉, Brid O’Brien 1, Margaret M Graham 1, Claire O’Donnell 1
PMCID: PMC7932284  PMID: 34394532

Abstract

Background

Globally, government and higher education institutions are expected to increase international student numbers. Programme development, marketing international collaboration and management has been the focus of strategy roll out.

Aims

This study aimed to explore international student experiences while undertaking Master of Science postgraduate education far from home.

Methods

A qualitative descriptive design was used. Following ethical approval, 11 students studying on a Master of Science Nursing postgraduate programme in one health education institute in Ireland volunteered to participate. Students were of Asian origin and mixed gender and the average age was 27. Data were collected using face-to-face semi-structured interviews and data analysis followed Burnard’s thematic framework.

Results

The data provide evidence of the complexities and challenges experienced when studying on a Master of Science postgraduate nursing programme. Students described a process of juggling to survive and succeed. Three overarching categories emerged: differing realities, working through, and learning new ways.

Conclusions

This study adds to international debate regarding structures and processes supporting international nurse education. In meeting ethnic and culturally-diverse student learning needs, consideration of learning and teaching approaches is warranted. For globalisation in nurse education to prosper, investment needs to move from focusing on recruitment towards structures and processes to nurture intercultural learning.

Keywords: intercultural learning, international education, learning and teaching approaches, nursing, postgraduate education

Introduction

Increasing internationalisation within education is a strategic objective for education providers globally (De Whit et al., 2015; European Commission, 2013). Higher education institutes (HEIs) continue to promote and attract international students in an ever-increasing target-driven education business market. Consequently, a rapid growth in student mobility within higher education across Europe has evolved (ICEF Monitor, 2015). However, the pressures associated with massification and globalisation are a concern for academics in maintaining quality learning experiences for a growing and increasingly diverse student population (Akalu, 2016; Malcolm and Zukas, 2000; Mok and Jiang, 2017). Massification has led to ever–increasing student numbers with diminishing resources. Nurse educators, like other disciplines, are tasked with developing internationalisation initiatives, predominantly aimed at increasing incoming student mobility (Brown et al., 2016; Dobrowolska et al., 2015; Valdez, 2015). Internationalisation of education is complex and may be described as an approach that prepares students to engage in an interconnected global world (Department of Education and Skills, 2016).

The value of studying abroad is internationally acknowledged (Brown et al., 2016; Kelleher et al., 2016; Sawir, 2013; Townsin, 2015). However, while the value of studying abroad is internationally acknowledged, it may be challenging. The challenges of moving to study in another country are widely reported and are intensified when adjusting to a new culture (Briones Connor and Michaels Miller, 2014; Doerr, 2012; Kelleher et al., 2016) with new pedagogies (Clerehan et al., 2011; Gonzales et al., 2017; Minn Chai et al., 2012) and language differences (Garone and Van De Craen, 2017). International education initiatives have predominantly focused on European undergraduate Erasmus programmes (Baernholdt et al., 2013; Brown et al., 2016; De Oliveira and Tuohy, 2015; Harrowing et al., 2012). In addressing global policy initiatives, the focus of international education has now extended to postgraduate programme development. Nonetheless, the views and experiences of postgraduate nursing students studying in a different country have received less attention.

Preparing nurse graduates to work in increasingly culturally diverse healthcare settings is a worldwide objective, but remains challenging (Hart and Mareno, 2014; Markey et al., 2018; McCarthy et al., 2013). The Council of Europe (2008) calls for intercultural dialogue and the intercultural classroom provides a safe space for students to learn with and from people from diverse cultural and ethnic backgrounds. Although there are a variety of terms used interchangeably in the literature to describe intercultural learning (Brown et al., 2016; Lee et al., 2014), the importance of learning to respect and communicate with people from different cultures as well as their own is consistently highlighted. Hollinderbaumer et al. (2013) define intercultural learning as the development of an understanding and appreciation of one’s own culture and that of others. Hammer (2012) and Harrowing et al. (2012) remind us that effective intercultural learning does not occur spontaneously. Appropriate pedagogies and classroom environments that encourage interaction and engagement are key to creating quality intercultural learning opportunities (Lee et al., 2014). Like many countries, Ireland has seen a rapid increase in incoming migration (Central Statistics Office, 2016) and has become a popular destination for international students, contributing to the unprecedented growth of cultural and ethnic diversity in the classroom. Such intercultural classrooms can enrich learning experiences for international (Sawir, 2013) and domestic students (Dunne, 2013) and teaching faculty (Markey and Tilki, 2007; Merrell et al., 2014). Much of the existing literature focuses on globalisation of curriculum design (Abdul-Mumin, 2016; Dunne, 2011; Khadizah, 2016; Markey et al., 2012) with less emphasis on exploring ways to maximise intercultural learning opportunities. Research is needed on intercultural learning models, in the context of a target–driven postgraduate sector and the massification of the university system (Malcolm and Zukas, 2000).

In response to this global movement, a 1-year full-time, taught Master of Science (MSc) Nursing Studies programme was designed for international students in our institution. The programme draws upon adult learning theories (Knowles, 1980), providing learning opportunities for students to foster increased independence, critical thinking and creativity. The programme structure recognises the importance of integration and individual and collaborative intercultural learning. Some modules are co-scheduled with students on other postgraduate programmes. Although internationalisation through study abroad is widely published, there is a paucity of research to date exploring the challenges for international postgraduate nursing students. How international students perceive, interact with and respond to the reality of intercultural learning opportunities warrants further consideration. Consequently, a study was undertaken which aimed to explore the experiences of international postgraduate students studying on an MSc Nursing Studies programme in one HEI in Ireland.

Methodology

In order to reach the study aims, a qualitative descriptive approach was adopted to explore experiences from students’ viewpoints. The choice is in keeping with Schwandt (2001) and Sandelowski (2010), whereby the goal is a straightforward description of data collection and analysis (Neergaard et al., 2009). A key strength of this approach is the detailed descriptions of experiences of students’ worldviews (Neergaard et al., 2009; Welford et al., 2012). Qualitative descriptive design is gaining momentum in generating valuable findings informing health education and practice (O’Brien et al., 2016). This approach endeavours to bring to light a narrative that has received little attention within international discourse.

Ethical considerations

This study was approved by the Research Ethics Committee of the University of Limerick. Ethical principles in research for this study were guided by Patten and Newhart (2018). Sensitivity of the potential power imbalances with international students and lecturers-as-researchers led to several processes being employed throughout the study. A gatekeeper was identified in keeping with best practice (Clark, 2011; McAreavey and Das, 2013). The gatekeeper was not involved in teaching or assessing potential students during recruitment, data collection and analysis. Information sheets were circulated to all potential students, inviting expressions of interest following completion of all assessments at the end of the programme. The voluntary nature of involvement was emphasised, and potential volunteers were informed that they could withdraw at any time without any repercussions. Time was given between invitation, consent and interview. Awareness of freedom of choice and protection of the rights of potential student participants underpinning research with a minority group was at the forefront throughout the research. Students as potential participants were assured of confidentiality and anonymity, and an identification number was used in all documentation, ensuring that no names of individuals would appear in the final report. Data were stored and managed in a password–protected computer in the principal investigator’s office, in keeping with Data Protection Act guidelines (Government of Ireland, 2009). These processes helped heighten awareness of the sensitive nature of ethical principles when conducting research with vulnerable groups. Nevertheless, the final choice to volunteer may be open to conjecture.

Sampling

The first MSc Nursing Studies cohort of 11 students was invited to participate. All 11 students volunteered and were enthusiastic in contributing to the study (Clerehan et al., 2011). Students were of Asian origin and mixed gender, with an average age of 27.

Data collection and analysis

Following ethical approval, students were invited to participate in face-to-face semi-structured interviews. Interviews took place at a time and venue of students’ choice in a private area. An interview guide using an open-ended questioning style guided the conversations. Interviews were facilitated by the first researcher (KM). Interviews lasted between 45 and 73 minutes, and were digitally recorded and transcribed verbatim with permission from students.

Data analysis followed Burnard et al.’s (2008) content analysis framework and commenced immediately after each interview. The first researchers (KM and BO'B) began by listening to the digital recording and reading and checking all transcripts. All researchers met and reviewed the data on a number of occasions. Following analysis of nine interviews, a rich description became evident. The remaining interviews confirmed that data saturation had been reached. Remaining open to the data, adopting a group approach to analysis and paying attention to the coherence between study aims, data collection, analysis and presentation of findings, aimed to enhance the rigour of this study (Finlay, 2006). Finally, analysis revealed a comprehensive description of three interrelated categories (Figure 1). The findings are illustrated throughout with verbatim quotes representative of the data.

Figure 1.

Figure 1.

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Juggling to survive.

Findings

The findings illustrate a narrative of students’ experiences of uncertainty in moving from Asia to an environment substantially different in terms of geographical, cultural, social, economic and education dimensions. An overarching process of juggling to survive and succeed was described. Different realities between traditional educational environments and the independent expectations of postgraduate-level study were evident. Findings show how students experienced different realities in working through and learning new ways to survive studying on the MSc postgraduate nursing programme.

Differing realities

The first category illustrates uncertainties that led to challenges for students when beginning the MSc programme, influencing engagement in learning experiences. All students spoke about environmental, social, cultural and economic differences. Searching and finding affordable accommodation was identified as a priority. A sense of loneliness and homesickness prevailed, and anxiety about the ability to survive and succeed on the programme was mentioned across all interviews. Students identified the importance of learning about Irish culture. Against the background of uncertainty was the centrality of meeting family expectations and responsibilities. On probing, students elaborated that the primary aim in coming to Ireland was to gain an internationally recognised qualification. Broadening career and promotional opportunities was essential in returning financial support to families at home:

The first challenge we faced was finding suitable accommodation. We didn’t know the market rate, where to stay, the most economical and what other expenses would need paying. (Interview 1)

It was much colder than we expected. (Interview 9)

The reality and emotional turmoil of arriving to live and study in a strange new environment is illustrated below:

I worried if I would survive in this new country, I was very lonely and sad for the first few months. (Interview 3)

I just was so afraid that I wouldn’t be able for it. (Interview 4)

Students described becoming aware of the cultural differences and an appreciation of learning about their new environment:

I have to learn and understand about the culture of Ireland, its food traditions, the way people do things. (Interview 9)

Adapting to a new country’s culture was really hard. (Interview 8)

At the beginning of students’ interactions in the classroom the cultural differences were explicit:

The Irish students in the class sat at one side, we sat together at the other side. (Interview 1)

The differing realities experienced on arrival in a new country far from home emerge across the data. The financial burden of reimbursing loans that were given by families to help students study in an Irish university added to the stress and concerns around the importance of succeeding:

We come here and need to work to pay [financial loans] our family back. So we must make it work. (Interview 5)

It was hard to get a job back home. I was trying to develop my academic career, when someone gets a certificate from a foreign university it’s a great thing. (Interview 8)

Looking back I was lost … everything was entirely different from what we expected. We had dreamt about it differently … we could not have prepared fully for it. (Interview 1).

Working through

Students described a process of working through their feelings and how they relied on old and familiar ways in dealing with change. Students spoke repeatedly about the struggles in coming to terms with different approaches to teaching and learning at the university. A noteworthy part of working through these struggles was the value of conversations with fellow international students in similar situations from similar cultural backgrounds. Students commented on the importance of help from peers. They voiced concerns around language proficiency and how communicating together in their native language helped. Initially students stayed close together within the classroom and shared fears of being judged by other students, influencing engagement in classroom activities. Gradually, students described taking opportunities to integrate within the class group:

I wanted them [faculty] to tell us what to learn and how to do it, rather than figure out ourselves what we needed to do. (Interview 5)

Students spoke about a reliance on family and fellow students from similar cultural backgrounds:

We learn everything from our family, we are very close and they always give good advice. (Interview 8)

The importance of the classroom environment was identified. Students spoke about gradually working through these dynamics:

The Irish students in the class sat at one side, we sat together at the other side … It is good talking with friends from home who understand. I was comfortable with them, and if I had a doubt, I could ask them in my local language. (Interview 1)

If we speak English we can’t express our emotions because English is our second language. (Interview 11)

We understand each other’s ways so we stay together. (Interview 10)

Over time, students illustrated the importance of interacting with all classmates and overcame what appeared to be feelings of inadequacy and discomfort:

Yeah, we thought will they [other students] like us? Are they ready to accept to us? So we sat separate from them. (Interview 7)

I was afraid in the group initially, but soon realised that if you talk with them they will talk back and we can learn and understand each other together. (Interview 9)

Everyone in class offered help … we helped each other with learning how to find and save articles. (Interview 7).

Learning new ways

A growing confidence in moving from traditional to new ways of learning was described. An appreciation of the critical nature of adult learning strategies was noted. Students described adopting a questioning approach to critical thinking, benefitting from opportunities to listen and learn with fellow students. As English language proficiency grew, students began to find it easier to engage in cross-cultural communication, whereby a growing sense of personal and professional achievement emerged. Communicating with fellow students and understanding academic expectations were integral to surviving and meeting MSc postgraduate programme demands and expectations, in learning new ways of studying.

Students spoke about beginning to understand and work through new educational strategies with which they were confronted at MSc postgraduate level:

Teaching and learning is entirely different and that’s a big challenge for us when we came, we were not used to that kind of teaching. (Interview 6)

Back home we do not give our opinion to the teachers. It took time to get used to the new custom of speaking to the teacher … At home teachers show us a book to learn from and the pages to read and learn off for exams … It’s like spoon-feeding. (Interview 6)

Students also spoke about the importance of developing critical thinking skills. Gradually students shared an appreciation and an ability to ask probing questions:

We realised that we can’t survive … without clearing our doubts so we ask questions and try to answer questions, nothing is ever clear, there seems to be many ways to answer. (Interview 1)

Watching and listening others present in class was good … Our old ways of thinking was that we should not ask questions of someone. But here it is different; we must question. (Interview 9)

Students referred to a growing sense of awareness and confidence in engaging in cross cultural communication:

Now if I see an Irish student or person sitting there … I don’t mind sitting and talking with them. (Interview 1)

I now know how to learn myself, it’s more than what my teachers are telling me (Interview 7).

Now we can deal with other cultures. (Interview 8)

A sense of personal and professional development and the ability to study and meet the expectations of MSc postgraduate study in another country emerged:

This was really good for me because I could experience a new culture, a way of learning, a way of creative thinking the (Interview 9).

I developed a lot; I can see the difference in how I am, academic learning and skills improved through the programme … I feel proud of what I have achieved. I’m confident that I can write anything now. Critical thinking is a new area that I have developed. (Interview 10).

Discussion

This study describes the experiences of international students undertaking an MSc postgraduate nursing programme in Ireland. Global policy directives, increasing incoming student mobility and the general growth of people migrating to Ireland in recent years have resulted in an unprecedented process of sociocultural diversification, exceeding any previous trends (Central Statistics Office, 2016). Vertovec (2007) refers to such growing trends in society as ‘super-diversity’, and Culley (2014) acknowledges the challenges of such ‘super-diversity’ for healthcare and nursing practice in particular. However, limited attention has been paid to the complexities of broadening cultural and ethnic diversity within the classroom. This study highlights the complexities associated with transitioning challenges for Asian students studying in Ireland. The findings highlight the different ways students responded to intercultural encounters and individual and collaborative learning in the intercultural classroom, in keeping with the work of Bennet (2004). Students appeared to navigate their way through a process of denial towards acceptance and integration of different ways of learning. Through engaging in learning activities with students from different backgrounds, they embraced the challenges of intercultural learning.

The narrative offers rich descriptions of the poignancy and personal struggles in striving to meet MSc-level education demands in a different country. ‘Juggling to survive’ illuminates a new way of framing students’ experiences within the broader goals of internationalisation in higher education. Hearing student experiences adds further insights into the complexities and realities of their journeys. Encouraging opportunities for international students to express their views and share their experiences contributes new insights into an under-researched area. The nursing classroom is a microcosm of any environment where people from diverse cultures bring different experiences, strengths and skills in working together towards achieving learning goals. An intercultural classroom provides an engaging opportunity for students to learn with, from and about students from different backgrounds (Hammer, 2012). The findings of this study, however, highlight that care, attention and sensitivity are required in order to ensure that such learning opportunities are appropriately facilitated and maximised.

Initially, students described preferences for traditional didactic teacher-led approaches and experienced challenges in learning about and through student-led approaches. Although these educational models may have served students well in meeting undergraduate requirements in their country of origin, they experienced new learning expectations for which they were unprepared. The demands and expectations required for success in postgraduate-level studies were a constant worry. Gradually, students developed increasing awareness and confidence in meeting programme expectations. A particularly significant development was seen in a shift by students towards more active learning styles, a finding that is in keeping with Heussi (2012). Challenges are intensified for international students when engaging in different learning environments far from home (Talebloo and Bin Baki, 2013). Students describe processes of overcoming personal, financial and social challenges encountered, illustrating personal determination to succeed. Language and academic literacies hindered initial learning and progress. In addressing these concerns, institutional support including academic literacy, language and study skills are essential. This is in keeping with recommendations for foundational studies preparation for intercultural learning (Dunne, 2013) and the need for intense language courses (Evans and Stevenson 2011; Garone and Van de Craen, 2017).

Intercultural learning has reported benefits within global education expansion towards increasing cultural sensitivity for both domestic and international students (Allen, 2010; Dunne 2011; Hammer, 2012). Findings from this study question the reality of leaving the development of cultural sensitivity to chance, as intercultural encounters in the classroom may not necessarily increase cultural sensitivity. Learning and teaching approaches need to embrace transformative learning approaches within a continuum of intercultural learning. Consideration is needed regarding intercultural classroom management as a means of providing an inclusive and engaged learning environment. There are conflicting views regarding organising classrooms as a means of maximising intercultural learning opportunities (Bennett, 2009). Balancing specific group learning opportunities and investment in resources is required to facilitate development from mono- to intercultural learning. Students described processes of staying close together in the classroom and beyond. Such self-segregation gave a sense of ease in sharing ideas as they understood each other, helping reduce fears of being judged. Students also described feeling comfortable staying close together, limiting the potential to engage fully in an intercultural learning environment. Gradually, students demonstrated the development of confidence, enabling them to integrate with domestic students, the benefits of which were clearly acknowledged. This is akin to Tilki et al.’s (2007) description of the ‘comfort zone’ whereby students feel more comfortable with individuals from similar backgrounds. Dunne (2011) concurs in highlighting students’ tendency to work in monocultural groupings as a consequence of anxiety and uncertainty.

The literature has paid attention to the structures and processes in curriculum design (Dunne, 2011; Kelleher et al., 2016). Little attention has been given to learner individuality being central to student engagement within the learning process. As a starting point, this study shares the experiences of 11 students, exposing the challenges in readdressing the balance between increasing student numbers and providing an outstanding learning experience. Rolfe (2013) argues that universities’ business focus on increasing student numbers is taking precedence over the support needs for student engagement in maximising learning for success. The essence of learning is fundamental to curriculum design and reform in implementing national and international globalisation policies. Thoughtful decision making and ethical practices are essential in balancing individual classroom dynamics and programme expectations in promoting quality intercultural, international and global learning.

Limitations

The exploratory nature of the study was not intended to be generalisable, and acknowledges that students self-selected for interviews and data may be influenced by a recollection of experiences. It is recognised that self-reported views are based on assumptions that students report their thoughts, experiences and opinions during interviews within a particular context and time. Furthermore, the researchers strived to keep ethical considerations to the fore throughout the research process. Data were collected with the first cohort of international students, and with time and experiences views may now have altered. Although this qualitative study took place in the context of an HEI in one region of Ireland, the descriptions may resonate for other educational institutes globally. Despite such limitations, findings provided valuable insights into student experiences and views which are not attainable simply through survey data.

Conclusion

This study shares new insights contributing to international discourse on the structures and processes supporting international nurse education. It endeavours to remind nurse educators of the day-to-day realities of how international students experience learning while juggling life and studying far from home. Individual, responsive and flexible learning supports are critical in helping students navigate their postgraduate programme in achieving their goals. It draws attention to the challenges in balancing strategic planning for international education, while providing individualised support within competing demands on nurse education resources. Students’ experiences and challenges bring to light the importance of providing support in promoting quality learning that capitalises on intercultural learning opportunities. For globalisation to prosper, investments need to move from focusing on recruitment towards creating meaningful structures to enable intercultural learning to flourish. This study extends the limited evidence to date that, while particularly relevant for Ireland, may be applicable to other countries with increasing growth of international postgraduate education. Further global discussions and research are essential in guiding nurse education learning strategies in supporting an ever-increasing and diverse student population.

Key points for policy, practice and/or research

  • Day-to-day realities for international postgraduate students in juggling life, study and balancing demands while studying abroad require consideration.

  • Globalisation and massification impact on quality learning environments in an increasingly diverse student population.

  • Education providers need to be mindful of the realities when developing education policies, practices and resources in supporting individual and collaborative learning, supports and educational practices.

  • Commitment to providing flexible, responsive, individual learning supports in creating meaningful intercultural learning environments is critical to successful globalisation of education.

Acknowledgements

We would like to express our gratitude to participants in this study who generously gave of their time.

Biography

Kathleen Markey is a Lecturer in the Department of Nursing and Midwifery at the University of Limerick, Ireland. Kathleen has been instrumental in leading on a number of internationalisation and international education initiatives within the department. Her particular research interests and scholarly activity are in the area of cultural diversity, intercultural education, cultural competence development and student learning.

Brid O’Brien is a Lecturer in the Department of Nursing and Midwifery at the University of Limerick, Ireland. Brid has been instrumental in developing a variety of international education initiatives for nursing students. Her principle areas of research interest include perioperative care, intercultural learning and nursing education for practice. She has been involved in initiatives, publications, research and work within this field for several years.

Margaret M Graham is a Lecturer in the Department of Nursing and Midwifery, University of Limerick. Student learning and exploring how we create dialogical learning spaces through reflection, fostering transferable learning from practice is central to her work. Developing and supporting person-centred care practices through narrative methodologies is a key area of interest.

Claire O’Donnell is a Lecturer in the Department of Nursing and Midwifery and is Course Director for International Studies in the department. Claire has contributed towards further developing the internationalisation agenda within the department and faculty with ethical considerations on this development to the fore. Her areas of research to date include general nursing care, stroke care, transcultural care, breastfeeding, culture and internationalisation.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Ethical approval

Ethical approval was obtained from Research Ethics Committee University of Limerick (EHSREC 2013-11-17).

Funding

The author(s) received no financial support for the research, authorship and/or publication of this article.

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